ADA Seeks Profession Input on CMS Interoperability, Prior Authorization Proposed Rule

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Posted: May 17, 2026

ADA Seeks Profession Input on CMS Interoperability, Prior Authorization Proposed Rule

Edited by Dentaltown staff

The American Dental Association is collecting feedback from dental stakeholders on a federal proposed rule that would expand electronic prior authorization requirements and interoperability standards across drug coverage, with the public comment period closing June 15.

The rule, formally titled the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P), was issued by the Centers for Medicare & Medicaid Services on April 10 and published in the Federal Register on April 14. It builds on the 2024 CMS Interoperability and Prior Authorization Final Rule and extends electronic prior authorization (ePA) requirements to drugs covered under both medical and pharmacy benefits.

Under the proposal, impacted payers would be required to support HL7 FHIR application programming interfaces and National Council for Prescription Drug Programs standards, including SCRIPT, Formulary & Benefit, and Real-Time Prescription Benefit. Payers would also need to publish annual prior authorization metrics and provide standardized reasons for coverage denials.

The association is hosting a May 21 stakeholder call to gather feedback on how the proposal could affect dental practices, oral surgery groups, hospital dentistry, and Medicaid-heavy organizations before submitting its formal comments to CMS. The input collected will shape the ADA’s Federal Register submission.

If finalized, the rule’s electronic prior authorization requirements would take effect Oct. 1, 2027, according to the agency. CMS has framed the proposal as part of a broader effort to reduce administrative burden, accelerate coverage decisions, and improve transparency around prior authorization denials.

Public comments may be submitted directly to CMS through the Federal Register before the June 15 deadline.

Sources:
ADA News, “ADA seeks input on proposed CMS rule on interoperability, prior authorization,” by Mary Beth Versaci, May 7, 2026: adanews.ada.org/ada-news/2026/may/ada-seeks-input-on-proposed-cms-rule
Centers for Medicare & Medicaid Services, “2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P)” overview, April 10, 2026: cms.gov/priorities/burden-reduction/overview/interoperability
Federal Register, “Medicare and Medicaid Programs, Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs,” April 14, 2026: federalregister.gov/documents/2026/04/14/2026-07205
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